This article is common in a series...

This article is common in a series of "Office Procedures" articles coordinated by dint of Thomas J. Zuber, M.D., Atlanta Medical Center Atlanta, Georgia.

Z-plasty is a plastic surgery technique used to improve the functional and cosmetic appearance of scars. It involves the creation of pair triangular flaps of equal dimension that are then transposed. (1)

For a basic z-plasty, the triangular flaps are created using an angle of 60 extents (Figures 1a through 1e). Theoretically, this angle can lengthen a contracted scar by dint of about 75 percent and reorient the direction of the central torture by 90 degrees. In practice, the lengthening and reorientation will be les owing to increased injury tension.

Angles smaller than 60 orders are easier to transpose if it were not that result in less lengthening and realignment of the scar to les than 90 orders Angles larger than 60 stations should be avoided because the force required to transpose the flaps increases markedly, making closure of the harm difficult. The length of each of the lateral limbs of the z-plasty must be precisely equal to the central incision through the whole extent of the original scar, or puckering at the corners will come and additional undermining and trimming of the flaps will be necessary to obtain meet closure. The multiple variations of the basic z-plasty are beyond the room of this article. (2)

In a primary care setting, z-plasty is reserv for improvement of linear, thin scars and is not used as a primary closure technique. The chiefly common situation in which a z-plasty would be used is an unfavorable cosmetic or functional scar that has not improved after waiting for a reasonable amplification of remodeling time (e.g., common year). More complicated scar situations, in the same state [i]or[/i] condition as burn scar contractures, wide scar contractures onward fingers, and hypertrophic or keloid scars, typically involve plastic surgery techniques other than basic z-plasty.

Indications

everyday indications for z-plasty include (1) lengthening of a contracted linear scar across a flexor crease (Figures 2a and 2b)--flexion contracture is released, and functionality across the scar is improved; and (2) changing the direction of a cosmetically unfavorable scar (Figure 3)--the scar is realigned along a natural skin gather or along the lines of least skin tension, creating les tension in succession the wound and resulting in a cosmetically superior scar appearance.

Technique

The mechanics of the technique must be clearly understood by means of the physician before the measure is attempted. The procedure and its risks and benefits are first explained to the patient, and an informed unison is obtained.

A basic z-plasty is performed using the stairs illustrated in Figures 1a by means of 1e.

The surgical site is prepp with an antibacterial solution, like as povidone-iodine (Betadine), and sterile drapes are applied.

sum of two units arms are drawn at each close of the linear scar, inscribing an angle of 60 ranks to the scar. The side arms are exactly equal in duration to the central scar and have precisely the same angle.

Local or regional anesthesia is administered.

Vertical incisions are made from one side the skin along the lines, using a no. 15 scalpel blade.

Full-thickness skin flaps are undermined at the flush of subcutaneous fat, creating pair triangular flaps of equal size and shape. Adequate undermining of surrounding subcutaneous tissue is performed to achieve fitting mobilization of the flaps.

The sum of two units flaps are then transposed around each other, changing the direction of the original scar.

The flaps are held in place with a not many anchoring stitches.

The skin is clos using interrupted line of junctions Corner stitches may be used for the flap tips.

Topical antibiotics and a press dressing are applied over the pain to minimize the chance of hematoma formation caused on the undermining.

The grief is re-examined in one to sum of two units days, and sutures are remov in seven to 14 days.

Complications

Z-plasty may be complicated through flap necrosis, hematoma formation, pain infection, sloughing of the flap caused according to high wound tension, and the trapdoor efficiency (elevation of central tissue resulting from a downward contraction of a surrounding scar).

most numerous complications may be prevented by dint of meticulous attention to technique.3 When possible, patients should be advised to stop taking anticoagulants before the surgery and if a hematoma is conception to be present during the postoperative course, large-bore needle aspiration may be performed. Routine injury care instructions are given to the patient, and prophylactic antibiotics may be considered for use in patients with diabetes and in other immunocompromised patients. The trapdoor event may be avoided by employing sufficient undermining of tissues surrounding the flap site.

The authors indicate that they do not have any conflicts of interests. Sources of funding: none reported.

REFERENCES

(1) shuffle aside M. Z-plasty. How, when and wherefore Aust Fam Physician 1997;26:1027-9.

(2) Zuber TJ Skin biopsy, excision, and repair techniques (illustrated manuals, videotapes, and CD-ROM of smooth tissue surgery techniques). Kansas City, Mo: American Academy of Family Physicians, 1998;52-61